| NPI | 1083424758 |
|---|---|
| Doing Business As | PRESTIGE DENTAL CENTER SOUTH (PUEBLO) |
| Entity Type | Organization |
| Authorized Contact | NICK SUNDIAM Credentialing Manager 719-300-5933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-01-13 |